Effects of an online flipped classroom model on nursing students’ infection control knowledge and psychomotor skills

Abstract Background Healthcare-associated infections remain a significant global public health challenge, and nurses require strong infection prevention and control competencies. Advances in digital education have accelerated adoption of online learning in nursing education. Objectives This study examined the effects of an entirely online flipped classroom model (FCM) on undergraduate nursing students’ infection control knowledge and psychomotor skills, addressing the limited evidence on whether a fully online FCM can support knowledge and skill acquisition across multiple, procedurally distinct psychomotor competencies within a single cohort. Design: A quasi-experimental pre-test–post-test control group design was conducted and reported per the TREND statement. Settings & Participants: The final sample comprised 76 first-year nursing students, matched on gender and GPA band and allocated to the experimental ( n = 38) or control ( n = 38) group through matched-group allocation by an independent statistician. Methods The control group received traditional online teacher-centered instruction; the experimental group participated in an online FCM comprising asynchronous interactive video-based learning with embedded formative questions and synchronous sessions including case discussions, self-directed skill practice, and peer-assessed skill demonstrations. Knowledge and psychomotor skills were assessed using a knowledge test and skill assessment forms evaluated by two independent, blinded assessors (ICC = 0.721–0.989); skills were assessed only post-intervention, with no baseline measurement. Results Pre-test knowledge scores were similar between groups ( p = 0.095). After adjusting for pre-test scores, the experimental group had significantly higher post-test knowledge scores than the control group ( p = 0.002), with a moderate effect size. The experimental group also showed higher post-intervention performance in hand hygiene and sterile glove donning/doffing than the control group, although these differences did not remain significant after correction for multiple comparisons and effect sizes were small to moderate. No significant differences were observed for personal protective equipment use or sterile field preparation. Conclusions An entirely online FCM may improve infection control knowledge and be associated with better post-intervention performance in selected psychomotor skills, although differences varied across skills and skill-specific findings should be interpreted as preliminary. Integrating online FCM with brief in-person or simulation-based practice may better support psychomotor competency development.